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Choe J, Koo HJ, Choi SJ, Lee SA, Kim DH, Song JM, Kang DH, Song JK, Kang JW, Yang DH. Differences in aortic valve area measured on cardiac CT and echocardiography in patients with aortic stenosis. PLoS One 2023; 18:e0280530. [PMID: 36662795 PMCID: PMC9858019 DOI: 10.1371/journal.pone.0280530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 12/29/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND A certain proportion of patients with severe aortic stenosis (AS) present with discordant grading between different diagnostic modalities, which raises uncertainty about the true severity of AS. The aim of this study was to compare the aortic valve area (AVA) measured on CT and echocardiography and demonstrate the factors affecting AVA discrepancies. METHODS Between June 2011 and March 2016, 535 consecutive patients (66.83±8.80 years, 297 men) with AS who underwent pre-operative cardiac CT and echocardiography for aortic valve replacement were retrospectively included. AVA was obtained by AVA on echocardiography (AVAecho) and CT (AVACT) using a measurement of the left ventricular outflow tract on each modality and correlations between those measures were evaluated. Logistic regression analysis was performed to identify factors affecting the discordance for grading severe AS. RESULTS The AVACT and AVAecho showed a high correlation (r: 0.79, P <0.001) but AVACT was larger than the AVAecho (difference 0.26 cm2, P <0.001). By using the cut-off values of AVACT (<1.2 cm2) and AVAecho (<1.0 cm2) for diagnosing severe AS, the BSA (odds ratio [OR]: 68.03, 95% confidence interval [CI]: 5.45-849.99; P = 0.001), AVAecho (OR: 1.19, 95%CI: 1.14-1.24; P <0.001), tricuspid valve morphology (OR: 2.83, 95%CI: 1.23-6.50; P = 0.01), and normalized annulus area (OR: 1.02; 95%CI:1.02-1.03; P <0.001) were significant factors associated with the discordance between the AVAecho and AVACT. CONCLUSION Patients with larger BSA, AVAecho, and annulus, and tricuspid valve morphology were associated with the AVA discordance between the echocardiography and CT. Complementary use of CT with echocardiography for grading severe AS could be helpful in such conditions.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Se Jin Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Seung-Ah Lee
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Lalude OO, Pugliese F, de Feyter PJ, Lerakis S. Complementary Imaging Techniques. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | | | - Stamatios Lerakis
- Emory University School of Medicine and Georgia Institute of Technology; Atlanta GA USA
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3
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Preoperative evaluation for coronary atherosclerosis with computed tomography angiography in intravenous drug users: an emerging indication in the face of a growing threat. Int J Cardiovasc Imaging 2015. [PMID: 26208684 DOI: 10.1007/s10554-015-0719-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to describe the application of coronary computed tomography angiography (CCTA) in evaluation of patients with history of intravenous drug use (IDU). An IRB approved retrospective review was performed of all patients who had a prior history of IDU and presenting with endocarditis who had undergone CCTA. Demographic characteristics and cardiovascular risk factors were collected. In addition, we reviewed CCTA reports for dosimetric parameters, calcium score, and atherosclerotic burden. There were 32 patients (25 males) included in this study with a mean age of 38 ± 10.8 years. The average BMI for the study group was 26.5 ± 4.9. 44 % of patients had evidence of atherosclerotic disease on coronary CTA. Mean calcium score was 175 ± 487. Median total exam effective dose was 4.8 mSv (range: 3.3-7.3 mSv). In spite of their relatively young age and BMI at the upper limits of normal, patients with history of IDU have atherosclerosis and coronary CTA can be utilized to screen these patients and may be helpful for risk stratification prior to noncoronary surgical procedures. Given the recent rise in IDU, this may become a growing indication for CCTA.
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Ko SM, Park JH, Shin JK, Kim JS. Assessment of the regurgitant orifice area in aortic regurgitation with dual-source CT: Comparison with cardiovascular magnetic resonance. J Cardiovasc Comput Tomogr 2015; 9:345-53. [DOI: 10.1016/j.jcct.2015.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 10/28/2014] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
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Gordic S, Alkadhi H. [Investigation techniques and importance of CT for diagnostics of cardiac valvular diseases]. Radiologe 2014; 53:864-71. [PMID: 24002182 DOI: 10.1007/s00117-012-2469-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
CLINICAL/METHODICAL ISSUE Cardiac computed tomography (CT) is the first-line modality for coronary assessment. In addition valvular morphology and function can be evaluated. STANDARD RADIOLOGICAL METHODS The method of choice for the evaluation of cardiac valves is echocardiography, followed by magnetic resonance imaging. METHODICAL INNOVATIONS Recent technical improvements and advances in temporal resolution allow a detailed anatomical and functional evaluation of the cardiac valves. PERFORMANCE Cardiac CT provides an excellent image quality of the aortic and mitral valve thus enabling an evaluation of the morphology. In addition, cardiac CT allows an assessment of aortic valve function with respect to the grading of stenosis and regurgitation. ACHIEVEMENTS Cardiac CT is not considered the first-line modality for the evaluation of cardiac valves; however, beyond coronary assessment CT provides important information on the morphology and function of cardiac valves. PRACTICAL RECOMMENDATIONS Cardiac CT can be a useful imaging alternative for patients in whom other more commonly used methods, such as echocardiography and magnetic resonance imaging fail to provide the necessary information.
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Affiliation(s)
- S Gordic
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz,
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Franco A, Fernández-Pérez G, Tomás-Mallebrera M, Badillo-Portugal S, Orejas M. Valvular heart disease: Multidetector computed tomography evaluation. RADIOLOGIA 2014. [DOI: 10.1016/j.rxeng.2014.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Franco A, Fernández-Pérez G, Tomás-Mallebrera M, Badillo-Portugal S, Orejas M. Enfermedad valvular cardíaca. Valoración con tomografía computarizada multidetector. RADIOLOGIA 2014; 56:219-28. [DOI: 10.1016/j.rx.2012.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 08/28/2012] [Accepted: 09/20/2012] [Indexed: 12/31/2022]
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8
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Feuchtner G. Imaging of cardiac valves by computed tomography. SCIENTIFICA 2013; 2013:270579. [PMID: 24490107 PMCID: PMC3893874 DOI: 10.1155/2013/270579] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 11/12/2013] [Indexed: 06/03/2023]
Abstract
This paper describes "how to" examine cardiac valves with computed tomography, the normal, diseased valves, and prosthetic valves. A review of current scientific literature is provided. Firstly, technical basics, "how to" perform and optimize a multislice CT scan and "how to" interpret valves on CT images are outlined. Then, diagnostic imaging of the entire spectrum of specific valvular disease by CT, including prosthetic heart valves, is highlighted. The last part gives a guide "how to" use CT for planning of transcatheter aortic valve implantation (TAVI), an emerging effective treatment option for patients with severe aortic stenosis. A special focus is placed on clinical applications of cardiac CT in the context of valvular disease.
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Affiliation(s)
- Gudrun Feuchtner
- Department of Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria
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9
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Larsen LH, Kofoed KF, Carstensen HG, Mejdahl MR, Andersen MJ, Kjaergaard J, Nielsen OW, Køber L, Møgelvang R, Hassager C. Aortic valve area assessed with 320-detector computed tomography: comparison with transthoracic echocardiography. Int J Cardiovasc Imaging 2013; 30:165-73. [DOI: 10.1007/s10554-013-0295-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/15/2013] [Indexed: 12/01/2022]
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10
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Anger T, Bauer V, Plachtzik C, Geisler T, Gawaz MP, Oberhoff M, Höher M. Non-invasive and invasive evaluation of aortic valve area in 100 patients with severe aortic valve stenosis: comparison of cardiac computed tomography with ECHO (transesophageal/transthoracic) and catheter examination. J Cardiol 2013; 63:189-97. [PMID: 24060524 DOI: 10.1016/j.jjcc.2013.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/28/2013] [Accepted: 08/01/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current guidelines place emphasis on the determination of aortic valve area (AVA) for defining an appropriate treatment strategy. Invasive and non-invasive modalities are used to perform planimetric [transesophageal echocardiography (TEE) and cardiac multidetector computed tomography (MDCT)] and calculated [catheter examination (CE), transthoracic echocardiography (TTE)] AVA measurements. PURPOSE AND METHODS We investigated 100 patients admitted to evaluate the AVA using cardiac MDCT (CT), TEE/TTE as well as invasive CE. RESULTS In all 100 patients we calculated a mean AVA of 0.79±0.29cm(2) (female 50/100, 0.70±0.19cm(2), male 0.9±0.21cm(2)) determined by all investigated examinations (mean±SEM). AVA measurements determined by CT were significantly greater (0.86±0.25cm(2)) than those determined by CE: 0.75±0.18cm(2), p=0.01. Echocardiographically determined AVA was comparable to CE (statistically not significant). Similar results were seen in all patients regardless of gender, presence of atrial fibrillation, and heart rate. We calculated a mean AVA for each patient and evaluated the variance of the AVA determined through investigated specific examinations as the bias. Overall, we found for CT 0.13±0.1cm(2), CE 0.13±0.11cm(2), TEE 0.16±0.09cm(2), and for TTE 0.16±0.08cm(2) a specific statistical non-significant variance. On subgroups: sinus rhythm, atrial fibrillation, females, males or combination, we found no further significant relevance for the specific variance. CONCLUSION Our data suggest the feasibility of cardiac MDCT to evaluate the correct AVA regardless of rhythm, heart rate, and sex. The planimetric concept to determine the AVA with CT displaces the "gold-standard" CE with respect to elucidating the potencies for complications, i.e. cerebral stroke. Regardless of CT's accessing of AVA measurement the TTE examination should remain the primary method of screening for aortic valve pathologies.
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Affiliation(s)
- Thomas Anger
- Department of Cardiology, Division of Medicine, Klinikum Calw-Nagold, Kliniken Calw, Germany.
| | - Verena Bauer
- Department of Cardiology, Division of Medicine II, Klinikum Bayreuth, Germany
| | - Claudia Plachtzik
- Department of Cardiology, Division of Medicine, Klinikum Calw-Nagold, Kliniken Calw, Germany
| | - Tobias Geisler
- Department of Cardiology, Division of Medicine III, University of Tübingen, Germany
| | - Meinrad P Gawaz
- Department of Cardiology, Division of Medicine III, University of Tübingen, Germany
| | - Martin Oberhoff
- Department of Cardiology, Division of Medicine, Klinikum Calw-Nagold, Kliniken Calw, Germany
| | - Martin Höher
- Department of Cardiology, Division of Medicine II, Klinikum Bayreuth, Germany
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Choy G, Kröpil P, Scherer A, El-Sherief AH, Chung J, Rojas CA, Abbara S. Pertinent reportable incidental cardiac findings on chest CT without electrocardiography gating: review of 268 consecutive cases. Acta Radiol 2013; 54:396-400. [PMID: 23436832 DOI: 10.1177/0284185113475918] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pertinent reportable cardiac findings on non-electrocardiography (ECG)-gated chest CT examinations have become easier to detect given recent advancements in multidetector CT technology. However, those findings are easily overlooked on routine chest CT without ECG gating given residual inherent cardiac motion artifact and non-cardiac indications. PURPOSE To describe and quantify the types of pertinent reportable cardiac findings that can be detected on chest CT examinations without ECG gating and evaluate how often they were reported. MATERIAL AND METHODS Two radiologists retrospectively reviewed (blinded to the original interpretation) 268 consecutive routine adult chest CT examinations without ECG gating for the presence of pertinent reportable cardiac findings. Retrospective interpretations were then compared with the original radiological reports. RESULTS One hundred and sixty-three patients (61%) had pertinent reportable cardiac findings. The findings encountered included: coronary artery disease (n = 131; 80.0%), coronary artery bypass grafts (n = 10; 6.1%), left ventricular aneurysm (n = 1; 0.6%), valve calcification (n = 131; 80.0%), valve repair/replacement (n = 5; 3.1%), pericardial effusion (n = 33; 20.2%), left atrial appendage thrombus (n = 1; 0.6%), cardiac mass (n = 1; 0.6%), and cardiac chamber enlargement (n = 29; 17.8%). On the original radiological reports 22.3% of the pertinent reportable cardiac findings, detected by the two radiologists retrospectively, were not reported. CONCLUSION Detection of pertinent reportable cardiac findings on routine chest CT examinations without ECG gating is possible. The high volume of chest CT examinations without ECG gating represents an opportunity for radiologists to comment on the presence or absence of cardiac disease which may influence future clinical decisions.
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Affiliation(s)
- Garry Choy
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Patric Kröpil
- Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Axel Scherer
- Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf, Germany
| | - Ahmed H El-Sherief
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan Chung
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Carlos A Rojas
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Suhny Abbara
- Cardiac Imaging Section, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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12
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Lee AM, Beaudoin J, Thai WE, Wai B, Hui GC, Sidhu MS, Engel LC, Abbara S, Hoffmann U, Ghoshhajra BB. Feasibility of aortic valve assessment with low dose prospectively triggered adaptive systolic (PTAS) cardiac computed tomography angiography. BMC Res Notes 2013; 6:158. [PMID: 23602055 PMCID: PMC3640955 DOI: 10.1186/1756-0500-6-158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 04/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac computed tomography angiography (CTA) is feasible for aortic valve evaluation, but retrospective gated protocols required high radiation doses for aortic valve assessment. A prospectively triggered adaptive systolic (PTAS) cardiac CT protocol was recently described in arrhythmia using second-generation dual-source CT. In this study, we sought to evaluate the feasibility of PTAS CTA to assess the aortic valve at a low radiation dose. FINDINGS A retrospective cohort of 29 consecutive patients whom underwent PTAS protocols for clinical indications other than aortic valve assessment and whom also received echocardiography within 2 months of CT, was identified. Images were reviewed for aortic valve morphology (tricuspid/bicuspid/prosthetic) and stenosis (AS) by experienced blinded readers. Accuracy versus echocardiography and radiation doses were assessed. CONCLUSIONS PTAS CTA protocols using second-generation dual-source CT for aortic valve evaluation are feasible at low doses. This protocol should be investigated further in larger cohorts.
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Nasis A, Mottram PM, Cameron JD, Seneviratne SK. Current and Evolving Clinical Applications of Multidetector Cardiac CT in Assessment of Structural Heart Disease. Radiology 2013; 267:11-25. [DOI: 10.1148/radiol.13111196] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Gaspar T, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Shiran A. Three-Dimensional Imaging of the Left Ventricular Outflow Tract: Impact on Aortic Valve Area Estimation by the Continuity Equation. J Am Soc Echocardiogr 2012; 25:749-57. [DOI: 10.1016/j.echo.2012.05.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Indexed: 01/05/2023]
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Achenbach S, Barkhausen J, Beer M, Beerbaum P, Dill T, Eichhorn J, Fratz S, Gutberlet M, Hoffmann M, Huber A, Hunold P, Klein C, Krombach G, Kreitner KF, Kühne T, Lotz J, Maintz D, Marholdt H, Merkle N, Messroghli D, Miller S, Paetsch I, Radke P, Steen H, Thiele H, Sarikouch S, Fischbach R. Konsensusempfehlungen der DRG/DGK/DGPK zum Einsatz der Herzbildgebung mit Computertomographie und Magnetresonanztomographie. KARDIOLOGE 2012. [DOI: 10.1007/s12181-012-0417-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hassan A, Nazir SA, Alkadhi H. Technical challenges of coronary CT angiography: Today and tomorrow. Eur J Radiol 2011; 79:161-71. [PMID: 20227210 DOI: 10.1016/j.ejrad.2010.02.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 02/14/2010] [Accepted: 02/17/2010] [Indexed: 11/27/2022]
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Schultz CJ, Papadopoulou SL, Moelker A, Nuis RJ, Kate GJT, Mollet NR, Geleijnse ML, de Feyter P, de Jaegere P, Serruys PW. Transaortic flow velocity from dual-source MDCT for the diagnosis of aortic stenosis severity. Catheter Cardiovasc Interv 2011; 78:127-35. [DOI: 10.1002/ccd.22958] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Pugliese F, de Feyter PJ. Multislice Computed Tomography of Coronary Arteries. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Mizia-Stec K, Pysz P, Jasiński M, Adamczyk T, Drzewiecka-Gerber A, Chmiel A, Krejca M, Bochenek A, Woś S, Sosnowski M, Gąsior Z, Trusz-Gluza M, Tendera M. Preoperative quantification of aortic valve stenosis: comparison of 64-slice computed tomography with transesophageal and transthoracic echocardiography and size of implanted prosthesis. Int J Cardiovasc Imaging 2011; 28:343-52. [PMID: 21279693 PMCID: PMC3288372 DOI: 10.1007/s10554-010-9784-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 12/23/2010] [Indexed: 11/30/2022]
Abstract
Precise measurements of aortic complex diameters are essential for preoperative examinations of patients with aortic stenosis (AS) scheduled for aortic valve (AV) replacement. We aimed to prospectively compare the accuracy of transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and multi-slice computed tomography (MSCT) measurements of the AV complex and to analyze the role of the multi-modality aortic annulus diameter (AAd) assessment in the selection of the optimal prosthesis to be implanted in patients surgically treated for degenerative AS. 20 patients (F/M: 3/17; age: 69 ± 6.5 years) with severe degenerative AS were enrolled into the study. TTE, TEE and MSCT including AV calcium score (AVCS) assessment were performed in all patients. The values of AAd obtained in the long AV complex axis (TTE, TEE, MSCT) and in multiplanar perpendicular imaging (MSCT) were compared to the size of implanted prosthesis. The mean AAd was 24 ± 3.6 mm using TTE, 26 ± 4.2 mm using TEE, and 26.9 ± 3.2 in MSCT (P = 0.04 vs. TTE). The mean diameter of the left ventricle out-flow tract in TTE (19.9 ± 2.7 mm) and TEE (19.5 ± 2.7 mm) were smaller than in MSCT (24.9 ± 3.3 mm, P < 0.001 for both). The mean size of implanted prosthesis (22.2 ± 2.3 mm) was significantly smaller than the mean AAd measured by TTE (P = 0.0039), TEE (P = 0.0004), and MSCT (P < 0.0001). The implanted prosthesis size correlated significantly to the AAd: r = 0.603, P = 0.005 for TTE, r = 0.592, P = 0.006 for TEE, and r = 0.791, P < 0.001 for MSCT. Obesity and extensive valve calcification (AV calcium score ≥ 3177Ag.U.) were identified as potent factors that caused a deterioration of both TTE and MSCT performance. The accuracy of AAd measurements in TEE was only limited by AV calcification. In multivariate regression analysis the mean value of the minimum and maximum AAd obtained in MSCT-multiplanar perpendicular imaging was an independent factor (r = 0.802, P < 0.0001) predicting the size of implanted prosthesis. In patients with AS echocardiography remains the main diagnostics tool in clinical practice. MSCT as a 3-dimentional modality allows for accurate measurement of entire AV complex and facilitates optimal matching of prosthesis size.
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Affiliation(s)
- Katarzyna Mizia-Stec
- Department of Cardiology, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland.
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Cardiac CT for the differentiation of bicuspid and tricuspid aortic valves: comparison with echocardiography and surgery. AJR Am J Roentgenol 2010; 195:900-8. [PMID: 20858816 DOI: 10.2214/ajr.09.3813] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the diagnostic performance of CT, compared with that of echocardiography and surgery, for differentiating between bicuspid and tricuspid aortic valves. MATERIALS AND METHODS Forty-seven patients with bicuspid valve and 47 patients with tricuspid aortic valve underwent retrospectively ECG-gated dual-source CT and echocardiography. Thirty-four (72%) of the 47 patients with bicuspid aortic valve underwent valve surgery. Two independent blinded observers assessed the CT image quality of the aortic valve during diastole and systole on a 4-point scale, determined which phase allowed the differentiation of valve type, distinguished between tricuspid and bicuspid aortic valves, and assessed for the presence of a raphe. Diagnostic performance of CT was determined using echocardiography and surgery as the reference standard. RESULTS According to echocardiography and surgery, seven (15%) of the 47 bicuspid aortic valves had no raphe, and 40 (85%) had a raphe. CT image quality was diagnostic (i.e., scores of 1-3) in all 94 patients in both diastole and systole. Among patients with bicuspid aortic valve and no raphe, differentiation between tricuspid and bicuspid aortic valves could be performed in diastole in 100% (7/7) of cases. Among patients with bicuspid aortic valve and raphe, differentiation was possible only in systole in 5% (2/40) of cases and when combining diastole and systole in 95% (38/40) of cases. In three bicuspid aortic valves with raphe, the valve was misclassified by CT as tricuspid aortic valve. Overall sensitivity and specificity of CT for the diagnosis of bicuspid aortic valve were 94% and 100%. CONCLUSION CT is highly accurate for differentiation between bicuspid and tricuspid aortic valves. For bicuspid aortic valves without raphe, diastolic reconstructions are sufficient, whereas in those with a raphe, additional reconstructions in systole are required.
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Ketelsen D, Fishman EK, Claussen CD, Vogel-Claussen J. Computed tomography evaluation of cardiac valves: a review. Radiol Clin North Am 2010; 48:783-97. [PMID: 20705173 DOI: 10.1016/j.rcl.2010.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Electrocardiograph (ECG)-gated cardiac computed tomography (CT) angiography has great potential for the evaluation of the cardiac valves, with excellent image quality. The evidence-based, established clinical role of ECG-gated CT coronary angiography provides additional valuable information about valve morphology and function. A wide range of valve pathology, including congenital and acquired conditions, infectious endocarditis, and complications of valve replacement, can be assessed by cardiac CT imaging. Despite recent advances in CT technology, echocardiography remains the gold standard for noninvasive cardiac valve evaluation. Nevertheless, important clinical information about the valves can be obtained with coronary CT angiography examinations. Thus cardiac valve morphology and function should be routinely assessed and reported on coronary CT angiography examinations.
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Affiliation(s)
- Dominik Ketelsen
- Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Eberhard-Karls-University Tuebingen, Germany
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Detection of aortic regurgitation with 64-slice multidetector computed tomography (MDCT). Acad Radiol 2010; 17:1006-11. [PMID: 20605488 DOI: 10.1016/j.acra.2010.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2010] [Revised: 04/07/2010] [Accepted: 04/08/2010] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the diagnostic accuracy of 64-row multidetector cardiac computed tomography (MDCT) in detecting aortic regurgitation (AR) on prospectively acquired images with trans-thoracic echocardiography (TTE) as a reference standard. MATERIALS AND METHODS Forty-three consecutive patients underwent MDCT and TTE. AR was defined on MDCT images acquired at 75% phase of R-R interval as the lack of aortic cusps coaptation. The maximum regurgitant orifice area (ROA) was planimetered and compared to TTE. RESULTS All 29 patients with AR on TTE were correctly identified by MDCT. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT were 100%, 85.7%, 93.5%, and 100%, respectively. Sixteen, nine, and four patients were found to have mild, moderate, and severe AR on TTE, respectively. The corresponding ROA by MDCT were 3.25 +/- 1.04 mm(2), 4.16 +/- 1.19 mm(2), and 11.30 +/- 6.13 mm(2), respectively. CONCLUSION MDCT data acquired for the coronary artery evaluation can be used for the detection of aortic regurgitation with high diagnostic accuracy without additional scanning or radiation and can support appropriate referral for TTE.
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del Valle-Fernández R, Jelnin V, Panagopoulos G, Dudiy Y, Schneider L, de Jaegere PT, Schultz C, Serruys PW, Grube E, Ruiz CE. A method for standardized computed tomography angiography-based measurement of aortic valvar structures. Eur Heart J 2010; 31:2170-8. [DOI: 10.1093/eurheartj/ehq093] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leschka S, Feuchtner G, Goetti R, Alkadhi H. Computed tomography of the coronary arteries in diagnosis. EXPERT OPINION ON MEDICAL DIAGNOSTICS 2010; 4:171-183. [PMID: 23484449 DOI: 10.1517/17530051003657654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
IMPORTANCE OF THE FIELD Cardiac computed tomography (CT) has recently emerged as a non-invasive alternative to catheter angiography for the assessment of coronary artery disease. Rapid technological advances have rendered coronary CT angiography to a robust, accurate and fast imaging modality to assess coronary artery disease in selected patients. The list of further indications in which cardiac CT is an appropriate test remains a topic of discussion. AREAS COVERED IN THIS REVIEW This review discusses the main literature available on the use of cardiac CT in the indications considered appropriate in the 2006 Appropriateness Criteria by the American College of Radiology with special emphasis on the temporal trends in the utilization of cardiac CT in clinical practice and in the opinion of the experts, and provides an outlook on how cardiac CT might evolve in the future. WHAT THE READER WILL GAIN The reader will gain insight into the strengths and shortcomings of CT of the coronary arteries in coronary artery diagnosis and will learn why cardiac CT is appropriate in some indications but not in others. TAKE HOME MESSAGE Recent research in cardiac CT has substantially improved the evaluation of the coronary arteries with CT, and the list of indications cardiac CT is appropriate for might expand further in the coming years.
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Affiliation(s)
- Sebastian Leschka
- University Hospital Zurich, Institute of Diagnostic Radiology, Zurich, CH-8091, Switzerland
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Jeon MH, Choe YH, Cho SJ, Park SW, Park PW, Oh JK. Planimetric measurement of the regurgitant orifice area using multidetector CT for aortic regurgitation: a comparison with the use of echocardiography. Korean J Radiol 2010; 11:169-77. [PMID: 20191064 PMCID: PMC2827780 DOI: 10.3348/kjr.2010.11.2.169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Accepted: 10/20/2009] [Indexed: 11/30/2022] Open
Abstract
Objective This study compared the area of the regurgitant orifice, as measured by the use of multidetector-row CT (MDCT), with the severity of aortic regurgitation (AR) as determined by the use of echocardiography for AR. Materials and Methods In this study, 45 AR patients underwent electrocardiography-gated 40-slice or 64-slice MDCT and transthoracic or transesophageal echocardiography. We reconstructed CT data sets during mid-systolic to enddiastolic phases in 10% steps (20% and 35-95% of the R-R interval), planimetrically measuring the abnormally opened aortic valve area during diastole on CT reformatted images and comparing the area of the aortic regurgitant orifice (ARO) so measured with the severity of AR, as determined by echocardiography. Results In the 14 patients found to have mild AR, the ARO area was 0.18±0.13 cm2 (range, 0.04-0.54 cm2). In the 15 moderate AR patients, the ARO area was 0.36 ± 0.23 cm2 (range, 0.09-0.81 cm2). In the 16 severe AR patients, the ARO area was 1.00 ± 0.51 cm2 (range, 0.23-1.84 cm2). Receiver-operator characteristic curve analysis determined a sensitivity of 85% and a specificity of 82%, for a cutoff of 0.47 cm2, to distinguish severe AR from less than severe AR with the use of CT (area under the curve = 0.91; 95% confidence interval, 0.84-1.00; p < 0.001). Conclusion Planimetric measurement of the ARO area using MDCT is useful for the quantitative evaluation of the severity of aortic regurgitation.
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Affiliation(s)
- Min Hee Jeon
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Plass A, Scheffel H, Alkadhi H, Kaufmann P, Genoni M, Falk V, Grünenfelder J. Aortic Valve Replacement Through a Minimally Invasive Approach: Preoperative Planning, Surgical Technique, and Outcome. Ann Thorac Surg 2009; 88:1851-6. [DOI: 10.1016/j.athoracsur.2009.08.015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Revised: 08/05/2009] [Accepted: 08/06/2009] [Indexed: 10/20/2022]
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Ropers D, Ropers U, Marwan M, Schepis T, Pflederer T, Wechsel M, Klinghammer L, Flachskampf FA, Daniel WG, Achenbach S. Comparison of dual-source computed tomography for the quantification of the aortic valve area in patients with aortic stenosis versus transthoracic echocardiography and invasive hemodynamic assessment. Am J Cardiol 2009; 104:1561-7. [PMID: 19932793 DOI: 10.1016/j.amjcard.2009.07.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 07/07/2009] [Accepted: 07/07/2009] [Indexed: 11/26/2022]
Abstract
We compared the measurements of the aortic valve area (AVA) using dual-source computed tomography (DSCT) in patients with mid to severe aortic stenosis to measurements using transthoracic echocardiography (TTE) and invasive hemodynamic assessment. A total of 50 patients (mean age 73 +/- 10 years) with suspected aortic stenosis were included. The computed tomographic data were acquired using DSCT with standardized scan parameters (2 x 64 x 0.6 mm collimation, 330-ms rotation, 120-kV tube voltage, 560 mA/rot tube current). After injection of 35 ml contrast agent (flow rate 5 ml/s), a targeted volume data set, ranging from the top of the leaflets to the infundibulum, was acquired. Ten cross-sectional data sets (slice thickness 1 mm, no overlap, increment 0.6 mm) were reconstructed during systole in 5% increments of the R-R interval. The AVA determined in systole by planimetry was compared to the calculated AVA values using the continuity equation on TTE and the Gorlin formula on catheterization. DSCT allowed the planimetry of the AVA in all patients. The mean AVA using DSCT was 1.16 +/- 0.47 cm(2) compared to a mean AVA of 1.04 +/- 0.45 cm(2) using TTE and 1.06 +/- 0.45 cm(2) using catheterization, with a significant correlation between DSCT/TTE (r = 0.93, p <0.001) and DSCT/cardiac catheterization (r = 0.97, p <0.001). However, DSCT demonstrated a slight, but significant, overestimation of the AVA compared to TTE (+0.12 +/- 0.17 cm) and catheterization (+0.10 +/- 0.12 cm(2)). In conclusion, DSCT permits one to assess the AVA with a high-image quality and diagnostic accuracy compared to TTE and invasive determination.
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LaBounty TM, Glasofer S, Devereux RB, Lin FY, Weinsaft JW, Min JK. Comparison of cardiac computed tomographic angiography to transesophageal echocardiography for evaluation of patients with native valvular heart disease. Am J Cardiol 2009; 104:1421-8. [PMID: 19892062 DOI: 10.1016/j.amjcard.2009.06.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2009] [Revised: 06/19/2009] [Accepted: 06/19/2009] [Indexed: 11/26/2022]
Abstract
Retrospectively gated helical cardiac computed tomographic angiography (CCTA) has been reported accurate in the evaluation of isolated valvular abnormalities, but its ability to provide comprehensive assessment of common valvular lesions is not established. We evaluated 56 consecutive patients undergoing 64-detector retrospective electrocardiogram-gated CCTA and transesophageal echocardiography for the presence of aortic and mitral stenoses, aortic and mitral regurgitations, mitral valve prolapse, and tricuspid regurgitation. Two cardiac computed tomographic angiographic readers measured maximum aortic and mitral valve opening areas, assessed for aortic or mitral valve regurgitant area, and evaluated for mitral valve prolapse. Tricuspid regurgitation was assessed by the contrast ratio of the inferior vena cava to the right heart. After excluding nondiagnostic valves on CCTA (mitral valve n = 4, aortic valve n = 2), the sensitivity, specificity, positive predictive values, and negative predictive values of CCTA compared to transesophageal echocardiography were 100%, 96%, 50%, and 100% for aortic stenosis, 44%, 96%, 67%, and 90% for aortic regurgitation, 100% each for mitral stenosis, 13%, 95%, 80%, and 45% for mitral regurgitation, and 50%, 98%, 80%, and 91% for mitral valve prolapse. There was no relation between tricuspid regurgitation grade and contrast ratio (p = 0.53). There was excellent interobserver agreement for aortic and mitral stenoses (kappa = 1.0 for each), and good agreement for aortic regurgitation, mitral regurgitation, and mitral valve prolapse (kappa = 0.81, 0.78, and 0.88, respectively). In conclusion, CCTA exhibited high diagnostic performance for detection of aortic and mitral stenoses and limited diagnostic performance for aortic regurgitation, mitral regurgitation, and mitral valve prolapse; tricuspid regurgitation could not be evaluated. The ability of CCTA to provide comprehensive assessment of valvular function is variable.
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Chen JJ, Manning MA, Frazier AA, Jeudy J, White CS. CT angiography of the cardiac valves: normal, diseased, and postoperative appearances. Radiographics 2009; 29:1393-412. [PMID: 19755602 DOI: 10.1148/rg.295095002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although echocardiography remains the principal imaging technique for assessment of the cardiac valves, contrast material-enhanced electrocardiographically gated computed tomographic (CT) angiography is proving to be an increasingly valuable complementary modality in this setting. CT angiography allows excellent visualization of the morphologic features and function of the normal valves, as well as of a wide range of valve diseases, including congenital and acquired diseases, infectious endocarditis, and complications of valve replacement. The number, thickness, and opening and closing of the valve leaflets, as well as the presence of valve calcification, can be directly observed. CT angiography also permits simultaneous assessment of the valves and coronary arteries, which may prove valuable in presurgical planning. Unlike echocardiography and magnetic resonance imaging, however, CT angiography requires ionizing radiation and does not provide a direct measure of the valvular pressure gradient. Nevertheless, with further development of related imaging techniques, CT angiography can be expected to play an increasingly important role in the evaluation of the cardiac valves. Supplemental material available at http://radiographics.rsna.org/cgi/content/full/29/5/1393/DC1.
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Affiliation(s)
- Joseph J Chen
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 S Greene St, Baltimore, MD 21201, USA.
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Achenbach S. Stress computed tomography myocardial perfusion: steps, questions, and layers. J Am Coll Cardiol 2009; 54:1085-7. [PMID: 19744617 DOI: 10.1016/j.jacc.2009.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Accepted: 05/05/2009] [Indexed: 12/01/2022]
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Planimetry of the aortic valve orifice area: comparison of multislice spiral computed tomography and magnetic resonance imaging. Eur J Radiol 2009; 77:426-35. [PMID: 19783394 DOI: 10.1016/j.ejrad.2009.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 08/17/2009] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to determine the comparability of multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) for measuring the aortic valve orifice area (AVA) and grading aortic valve stenosis. MATERIALS AND METHODS Twenty-seven individuals, among them 18 patients with valvular stenosis, underwent AVA planimetry by both MSCT and MRI. In the subset of patients with valvular stenosis, AVA was also calculated from transthoracic Doppler echocardiography (TTE) using the continuity equation. RESULTS There was excellent correlation between MSCT and MRI (r = 0.99) and limits of agreement were in an acceptable range (± 0.42 cm(2)) although MSCT yielded a slightly smaller mean AVA than MRI (1.57 ± 0.83 cm(2) vs. 1.67 ± 0.98 cm(2), p < 0.05). However, in the subset of patients with valvular stenosis, the mean AVA was not different between MSCT and MRI (1.05 ± 0.30 cm(2) vs. 1.04 ± 0.39 cm(2); p > 0.05). The mean AVAs on both MSCT and MRI were systematically larger than on TTE (0.88 ± 0.28 cm(2), p < 0.001 each). Using an AVA of 1.0 cm(2) on TTE as reference, the best threshold for detecting severe-to-critical stenosis on MSCT and MRI was an AVA of 1.25 cm(2) and 1.30 cm(2), respectively, resulting in an accuracy of 96% each. CONCLUSION Our study specifies recent reports on the suitability of MSCT for quantifying AVA. The data presented here suggest that certain methodical discrepancies of AVA measurements exist between MSCT, MRI and TTE. However, MSCT and MRI have shown excellent correlation in AVA planimetry and similar accuracy in grading aortic valve stenosis.
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Gaztanaga J, Pizarro G, Sanz J. Evaluation of cardiac valves using multidetector CT. Cardiol Clin 2009; 27:633-44. [PMID: 19766920 DOI: 10.1016/j.ccl.2009.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac CT is an accurate and reasonable alternative modality for valvular imaging. It is used primarily for the evaluation of coronary artery disease; however, important information regarding valvular anatomy and function can be derived from CT. Calcification is a common CT finding in various valvular abnormalities and carries important diagnostic and prognostic value. In addition, valvular morphology, stenosis, and regurgitation also are detected on contrast enhanced scans, with good correlation with trans-thoracic echocardiography and other techniques.
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Affiliation(s)
- Juan Gaztanaga
- Division of Cardiology, Department of Medicine, Mount Sinai School of Medicine, One Gustave Levy Place, New York, NY 10029, USA
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Pernès JM, Sirol M, Chabbert V, Christiaens L, Alison D, Hamon M, Caussin C. Les indications actuelles du scanner cardiaque. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2009. [DOI: 10.1016/s1878-6480(09)70351-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Comprehensive assessment of the severity and mechanism of aortic regurgitation using multidetector CT and MR. Eur Radiol 2009; 20:326-36. [DOI: 10.1007/s00330-009-1544-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
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The Aortic Root: Comparison of Measurements From ECG-gated CT Angiography With Transthoracic Echocardiography. J Thorac Imaging 2009; 24:223-6. [DOI: 10.1097/rti.0b013e31819f9369] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Differences in Aortic Valve Area Measured with CT Planimetry and Echocardiography (Continuity Equation) Are Related to Divergent Estimates of Left Ventricular Outflow Tract Area. AJR Am J Roentgenol 2009; 192:1668-73. [DOI: 10.2214/ajr.08.1986] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Feuchtner GM. The utility of computed tomography in the context of aortic valve disease. Int J Cardiovasc Imaging 2009; 25:611-4. [PMID: 19468861 DOI: 10.1007/s10554-009-9472-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 05/20/2009] [Indexed: 11/25/2022]
Affiliation(s)
- Gudrun M Feuchtner
- Department of Radiology II, Innsbruck Medical University, Innsbruck, Austria.
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Shah RG, Novaro GM, Blandon RJ, Whiteman MS, Asher CR, Kirsch J. Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography. Int J Cardiovasc Imaging 2009; 25:601-9. [DOI: 10.1007/s10554-009-9464-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 04/22/2009] [Indexed: 11/24/2022]
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Arnoldi E, Johnson TR, Rist C, Wintersperger BJ, Sommer WH, Becker A, Becker CR, Reiser MF, Nikolaou K. Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques. Eur Radiol 2009; 19:2147-55. [PMID: 19415293 DOI: 10.1007/s00330-009-1411-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 02/18/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
Abstract
The goal of our study was to compare a prospective triggering (PT) CT technique with retrospectively gated (RG) CT techniques in coronary computed tomographic angiograms (CCTA) with respect to image quality and radiation dose. Sixty consecutive patients were enrolled. CCTAs using the RG technique were obtained with a dual-source 64-slice CT system in 40 patients, using ECG-triggered tube current modulation, with either a broad pulsing window at 30-80% of the RR interval (group RGb, 20 patients, heart rate > 70 bpm) or a small pulsing window at 70% (group RGs, 20 patients, heart rate < 70 bpm). The other 20 patients underwent CCTA using the PT technique on a 128-slice CT system (group PT, heart rate < 70 bpm). All images were evaluated by two observers for quality on a three-point scale, with 1 being excellent and 3 being insufficient. The effective radiation dose was calculated for each patient. The average image quality score was 1.5 +/- 0.6 for PT, 1.35 +/- 0.5 for RGs and 1.65 +/- 0.5 for RGb. The mean effective dose for RGb was 9 +/- 4 mSv, for RGs 7 +/- 3 mSv and for PT 3 +/- 1 mSv. This represents a 57% dose reduction for PT compared with RGs and a 67% dose reduction for PT compared with RGb. In conclusion, in selected patients CCTA with the PT technique offers adequate image quality with a significantly lower radiation dose compared with CCTA using RG techniques.
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Affiliation(s)
- Elisabeth Arnoldi
- Department of Clinical Radiology, University Hospitals Munich-Grosshadern Campus, Ludwig-Maximilians University, Marchioninistrasse 15, Munich 81377, Germany.
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Noncoronary applications of cardiac multidetector row computed tomography. JACC Cardiovasc Imaging 2009; 1:94-106. [PMID: 19356412 DOI: 10.1016/j.jcmg.2007.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 10/14/2007] [Accepted: 10/17/2007] [Indexed: 12/11/2022]
Abstract
Multidetector row computed tomography (MDCT) has a high diagnostic accuracy to evaluate coronary artery stenoses. Additionally, the 4-dimensional aspect of cardiac MDCT allows a comprehensive evaluation of cardiac structure and function. Left ventricular volumes and systolic function can be accurately assessed with MDCT, and imaging of myocardial infarction is a promising application of cardiac MDCT. In addition, MDCT may provide anatomical visualization of heart valves. Also, evaluation of anatomy of the pulmonary veins and cardiac venous system render MDCT a valuable tool for the cardiologist performing electrophysiological procedures. In this article, the role of MDCT in the noninvasive evaluation of cardiac structure and function is discussed. An overview of the wide range of noncoronary applications of cardiac MDCT is provided, focusing on the assessment of left ventricular function, valvular heart disease, and cardiac venous anatomy.
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Akhtar M, Tuzcu EM, Kapadia SR, Svensson LG, Greenberg RK, Roselli EE, Halliburton S, Kurra V, Schoenhagen P, Sola S. Aortic root morphology in patients undergoing percutaneous aortic valve replacement: Evidence of aortic root remodeling. J Thorac Cardiovasc Surg 2009; 137:950-6. [DOI: 10.1016/j.jtcvs.2008.07.062] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2008] [Revised: 07/16/2008] [Accepted: 07/31/2008] [Indexed: 10/21/2022]
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Stolzmann P, Knight J, Desbiolles L, Maier W, Scheffel H, Plass A, Kurtcuoglu V, Leschka S, Poulikakos D, Marincek B, Alkadhi H. Remodelling of the aortic root in severe tricuspid aortic stenosis: implications for transcatheter aortic valve implantation. Eur Radiol 2009; 19:1316-23. [DOI: 10.1007/s00330-009-1302-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 12/08/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
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Dennie CJ, Leipsic J, Brydie A. Canadian Association of Radiologists: Consensus Guidelines and Standards for Cardiac CT. Can Assoc Radiol J 2009; 60:19-34. [DOI: 10.1016/j.carj.2009.02.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Carole J. Dennie
- Department of Diagnostic Imaging, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada
| | - Jonathan Leipsic
- Department of Radiology, Division of Cardiology, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Alan Brydie
- Department of Radiology, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
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Chun EJ, Choi SI, Lim C, Park KH, Chang HJ, Choi DJ, Kim DH, Lee W, Park JH. Aortic stenosis: evaluation with multidetector CT angiography and MR imaging. Korean J Radiol 2009; 9:439-48. [PMID: 18838854 PMCID: PMC2627207 DOI: 10.3348/kjr.2008.9.5.439] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aortic valvular stenosis (AS) is the most common valve disease which results in the need for a valve replacement. Although a Doppler echocardiography is the current reference imaging method, the multidetector computerized tomograpghy (MDCT) and magnetic resonance imaging (MRI) have recently emerged as a promising method for noninvasive valve imaging. In this study, we briefly describe the usefulness and comparative merits of the MDCT and MRI for the evaluation of AS in terms of valvular morphology (as the causes of AS), quantification of aortic valve area, pressure gradient of flow (for assessment severity of AS), and the evaluation of the ascending aorta and cardiac function (as the secondary effects of AS). The familiarity with the MDCT and MRI features of AS is considered to be helpful for the accurate diagnosis and proper management of patients with a poor acoustic window.
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Affiliation(s)
- Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, Korea
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Garcia MJ. Evaluation of Valvular Heart Disease by Cardiac Magnetic Resonance and Computed Tomography. VALVULAR HEART DISEASE: A COMPANION TO BRAUNWALD'S HEART DISEASE 2009:101-112. [DOI: 10.1016/b978-1-4160-5892-2.00007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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